18F-脱氧葡萄糖PET/CT代谢参数对食管恶性肿瘤患者放化疗疗效的预测价值

居热提·阿扎提 柴黎明 娜仁花

摘要：目的  探討18F-脱氧葡萄糖（18F-FDG）PET/CT代谢参数对食管恶性肿瘤患者放化疗疗效的预测价值。方法  回顾性分析2012年1月～2016年12月在新疆维吾尔自治区人民医院行单独放疗或放化疗联合治疗的52例哈萨克族食管癌患者的临床资料，均行全身PET/CT扫描，分析临床各相关因素对肿瘤原发灶的SUVmax与MTV的影响及其与病变长度、浸润深度、淋巴结转移、临床分期的关系;另根据近期疗效评价标准分为治疗有效组和治疗无效组，比较两组SUVmax和MTV及其与放化疗后病灶近期疗效的关系。结果  不同年龄、性别、肿瘤部位、病灶长度、肿瘤分化程度、淋巴结转移情况患者的SUVmax和MTV比较，差异无统计学意义（P>0.05）;不同病灶浸润深度及临床分期患者的MTV比较，差异有统计学意义（P<0.05），但不同病灶浸润深度及临床分期患者的SUVmax比较，差异无统计学意义（P>0.05）。Pearson相关性分析显示，MTV与食管肿瘤的病灶长度、浸润深度及临床分期呈正相关（P<0.05），与淋巴结转移无相关性（P>0.05）;SUVmax与食管肿瘤的淋巴结转移以及临床分期呈正相关（P<0.05），与病灶长度、浸润深度无相关性（P>0.05）。治疗后，CR 21例（40.39%），PR 13例（25.00%），SD 10例（19.23%），PD 8例（15.38%），治疗总有效率为65.38%。治疗有效组与治疗无效组的SUVmax分别为（13.09±10.95）、（12.55±4.98），二者比较，差异无统计学意义（P>0.05）;治疗有效组与治疗无效组的MTV分别为（44.66±24.85）、（68.20±47.39），二者比较，差异有统计学意义（P<0.05）。Spearman相关性分析显示，MTV与近期疗效呈正相关（P<0.05），SUVmax与近期疗效无相关性（P>0.05）。结论  哈萨克族食管癌患者的肿瘤病灶长度、浸润深度、淋巴结转移及临床分期对SUVmax与MTV有不同的影响，且MTV相较于SUVmax有更高的预测价值，值得进一步深入研究。

关键词：PET-CT;食管肿瘤;最大标准摄取值;肿瘤代谢体积

中图分类号：R735.2                                文献标识码：A                                  DOI：10.3969/j.issn.1006-1959.2020.05.024

文章编号：1006-1959（2020）05-0080-05

Abstract：Objective  To investigate the predictive value of 18F-deoxyglucose （18F-FDG） PET/CT metabolic parameters on the efficacy of radiotherapy and chemotherapy in patients with esophageal malignant tumors.Methods  The clinical data of 52 Kazakh esophageal cancer patients who underwent radiotherapy alone or combined with chemotherapy in the Xinjiang Uygur Autonomous Region People's Hospital from January 2012 to December 2016 were retrospectively analyzed. All patients underwent whole-body PET/CT scans to analyze clinical data. The influence of related factors on the SUVmax and MTV of the primary tumor and its relationship with the length of the lesion， the depth of invasion， lymph node metastasis， and clinical stage; according to the short-term efficacy evaluation criteria， it was divided into a treatment effective group and a treatment ineffective group.SUVmax and MTV were compared between the two groups and their relationship with the short-term efficacy of the lesions after radiotherapy and chemotherapy. Results  There was no significant difference in SUVmax and MTV between patients of different ages， genders， tumor locations， lesion length， tumor differentiation， and lymph node metastasis （P>0.05）.There was a statistically significant difference in the depth of infiltration of different lesions and the MTV of patients in clinical stages（P<0.05）.However， there was no significant difference in SUVmax between patients with different lesion infiltration depth and clinical stage （P>0.05）. Pearson correlation analysis showed that MTV was positively correlated with lesion length， invasion depth， and clinical stage of esophageal tumors （P<0.05）， but not related to lymph node metastasis （P>0.05）;SUVmax was positively correlated with lymph node metastasis and clinical stage of esophageal tumors （P<0.05）， and had no correlation with lesion length and depth of invasion （P> 0.05）. After treatment， 21 patients were CR （40.39%）， 13 patients were PR （25.00%）， 10 patients were SD （19.23%）， and 8 patients were PD （15.38%）. The total effective rate was 65.38%.The SUVmax of the treatment-effective group and the treatment-ineffective group were （13.09±10.95） and （12.55±4.98）.There was no statistically significant difference between the two （P>0.05）; the MTV of the treatment-effective group and the ineffective group were （44.66±24.85） and （68.20±47.39），the difference was statistically significant （P<0.05）. Spearman correlation analysis showed that MTV was positively correlated with short-term efficacy （P<0.05）， and SUVmax was not correlated with short-term efficacy （P>0.05）. Conclusion  The tumor length， invasion depth， lymph node metastasis， and clinical stage of Kazakh esophageal cancer patients have different effects on SUVmax and MTV， and MTV has higher predictive value than SUVmax， which deserves further study.

Key words：PET-CT;Esophageal tumor;Maximum standard uptake value;Tumor metabolic volume

食管恶性肿瘤（esophageal cancer）为我国常见的消化道肿瘤之一，在不同地区及各民族间其死亡率差异较大[1]。哈萨克族……